Iowa sets a high bar for HCW flu vaccination
States top feds with 95% immunization goal
Many hospitals would be happy to lift their rate of health care worker influenza immunization past 60% or 70%, but in Iowa, the bar is quite a bit higher than that. In fact, it is near perfection.
By 2010, the Iowa Health Care Collaborative in Des Moines wants hospitals to attain a 95% influenza vaccination rate. And some of them have already achieved that or come very close without mandatory vaccination.
The Iowa experience is an example of growing state efforts to boost influenza vaccination of health care workers. State health departments, quality improvement organizations, and even legislatures have made influenza vaccination a priority. California was the first state to require either vaccination or declination statements from hospital workers. Other states, such as Minnesota, have established goals of 90% immunization of health care workers.
The Iowa collaborative, a nonprofit quality improvement organization created by the Iowa Hospital Association and the Iowa Medical Society, set goals for Healthy Iowans 2010 that are significantly higher than the federal Healthy People 2010 goal of immunizing 60% of health care workers.
"Hospitals have engaged in the goal. I think it's just because they know it's the right thing to do," says Gerd Clabaugh, MPA, the collaborative's director of operations. "They've begun working with their staff to encourage immunization."
For a few years, Virginia Mason Medical Center in Seattle stood alone with a mandatory influenza vaccination policy that enabled the hospital to vaccinate 98% of its employees. (Those with medical contraindications must wear a mask during flu season, as do unionized nurses who decline the vaccine. A court ruled they could not be required to have the vaccine.) Quietly, other hospitals have moved toward mandatory vaccination in an effort to reach the highest levels of coverage.
Yet Clabaugh asserts that hospitals can reach a 95% vaccination rate without making the vaccine a condition of employment. "We have not advocated that hospitals consider going to mandatory vaccination," he says. "A few hospitals in the state have done that on their own, [but] we have not suggested or sought that."
'Mentor hospitals' share strategies
When the Iowa Healthcare Collaborative began its immunization effort, Iowa hospitals had already made progress in vaccinating health care workers. In 2006-2007, 68% of hospital employees were immunized, according to baseline reporting data.
Last year, in 2007-2008, 76% of Iowa's hospital employees received the flu vaccine. By contrast, nationally, 42% of health care workers received the vaccine in 2006, according to the National Health Interview Survey.
"We're feeling good about the fact that we're so much higher than the national average, but we're still short of the [95%] goal," says Clabaugh.
"This is a very important program for us," he says. "It strikes a chord with a lot of hospital staff and it does a lot to prevent hospital infections."
The collaborative highlights "mentor hospitals" willing to share their successful strategies. (www.ihconline.org/toolkits/immunizationhealthcareworkers.cfm.)
The collaborative emphasizes the following "critical success factors":
- Leadership buy-in
- Endorse and promote APIC (Association for Professionals in Infection Control and Epidemiology) Influenza Toolkit
- Make vaccination easily accessible
- Develop a physician/clinical champion
- Accurately track immunizations given and declination of participation
- Develop an organizational plan to coordinate all critical success factors.
Education before vaccination
As with most hospitals, influenza vaccination of health care workers began to take a higher priority at Waverly (IA) Health Center in northeast Iowa about five years ago, when national quality improvement organizations began to focus on the patient safety implications. Last year, Waverly reached its pinnacle: 95% of the 400 employees received the influenza vaccine.
Education sessions, mobile carts, and intensive follow-up are critical strategies for the 25-bed critical access hospital, which has an active emergency department and outpatient surgery, says Dixie Kramer, RN, CIC, manager of infection prevention, employee health and occupational health.
"We probably get 60%-75% of the people in those first three days [of the vaccination campaign]. The hard work comes after that," she says.
The hospital kicked off its vaccination campaign with posters designed by the marketing department and educational sessions led by a physician. Employees who were unable to attend the session viewed an online PowerPoint presentation and took a quiz to demonstrate their knowledge.
This year, the hospital is continuing the educational approach with "myth-buster" handouts that counter common reasons for refusing the vaccine. ("I'm afraid I'll get the flu from the flu vaccine, I never get the flu so I don't need it," etc.)
There are pre-printed influenza vaccine consent forms with each employee's name. Anyone who chooses to decline must meet with Kramer to discuss the vaccine. This year, managers will help track down employees who have not received the vaccine or signed a declination, says Kramer.
While the emphasis is on protecting patients, Waverly does provide an incentive. Vaccinated employees receive five "wave" points as part of a "service excellence" program; the points accumulate and can be redeemed for gifts.
Kramer hopes employees will simply become accustomed to getting their vaccine every year, but she isn't taking anything for granted. "It still takes vigilance. It still takes a concerted effort," she says. "Now that we've hit 95, we sure don't want to fall off of that."
'Jump through hoops' for declination
Winneshiek Medical Center in Decorah, IA, has come close to mandating the influenza vaccine. Employees who choose to decline it must answer a questionnaire on facts about influenza and attend an educational program with the physician who champions the influenza vaccination program.
"They have to jump through a few hoops to sign a declination," says Brenda Schwan, BSN, RN, infection prevention and control and employee health nurse.
Schwan also tries to respond to employee concerns. For example, if an employee is reluctant because the vaccine contains the preservative thimerosol, Schwan will administer two of the pediatric doses, which are thimerosol-free. "There have been a lot of people I've been able to convince to try it," Schwan says.
Last year, 93.5% of those with direct patient care contact received the vaccine, and overall 91.6% of the hospital and clinic's 400 employees were vaccinated. Just 12 employees declined the vaccine.
While Schwan acknowledges that she may not be able to convince those last employees to roll up their sleeves, she continues with a lively promotion. This year, the theme is based on the MasterCard ad campaign, "Priceless." It will detail the costs of a case of influenza for a patient or employee. The flu shot is free. And not having to use your paid time off because of influenza? Priceless.
Departments that have 100% vaccination enter a drawing for a pizza party. And when they get their vaccine, employees enter a raffle for a free lunch in the cafeteria.
Meanwhile, Schwan tries to impress newly hired employees of the importance of the annual flu vaccine. "I tell them it's expected that you get your flu shot," she says. "They're learning that from the get-go."
Many hospitals would be happy to lift their rate of health care worker influenza immunization past 60% or 70%, but in Iowa, the bar is quite a bit higher than that. In fact, it is near perfection.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content